WILL MEDICARE PAY FOR THE LAP OR THE RNY IN FL???

Hey Guys, I am from Illinois, but have a friend who lives in Tampa FL that is on Medicare and was looking into the Lap or RNY.  Well he was told that it isn't covered. I'm not to sure about Medicare and my traditional plan paid for my surgery and after care.  Is anyone familiar with Medicare and what this person needs to do??? Your help is appreciated. Many Blessings

Medicare issued a decision memo in Feb 2006 indicating that WLS was a covered benefit for medicare beneficiaries.  Medicare is a federal program and while coverage should not vary from state to state like it does for medicaid, some the Medicare HMO's muck up the works.  The only caveat was that the surgeon and hospital both have to either the Center of Excellence designation from ASBS or the Level 1 designation from the ACS.  The problem comes when people have opted for participating in some of the medicare HMO's.  Does your friend have straight Medicare or one of the HMO's?   There are several surgeons in Florida that have the COE so be sure your friend checks with one of those surgeons.  But and this is another clincher.  Just having the COE or Level I does not mean the surgeon will accept Medicare assignment.  That may prove to be the difficult part -- finding a COE provider that will accept medicare assignment.  There is a sticky message on the top of this board about surgeons that will accept medicare. red ETA:  You can find the Medicare Decision Memo at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewde cisionmemo.asp&id=160&

Thanks.  I'm not sure if its straight Medicare or one of the HMO's, but I will find out.   Once I ask, I may have to ask you more questions if you don't mind

Please feel free, although I am no expert in such matters.  I hope your friend is able to get the surgery.  I remember when the medicare decision was published and for us DSers it was wonderful validation.  But the COE part of the decision made it difficult for a lot people who qualify for surgery to get it. 

Hello - I am writing for my husband who had the rnygb on Feb. 28th.  Medicare did pay as his primary insurance.  We went through the Cleveland Clinic in Weston, Fl. and followed their guidelines. We submitted all of the paperwork required from all of his doctors and they submitted it to Medicare.  He had an approval the same day.  I will stress the importance of having the necessary information for the insurance company.  we submitted medical records from all doctors and from his primary showing that he had been on a supervised diet for some time.  He had clearances and testing and a letter from the bariatric surgeon.  Hope this helps.

I work for a insurance company that has to follow medicare guildlines and the surgery is covered however u most have either hig blood pressure or diabetes.......